Apria Healthcare Group has agreed to pay a $40 million nationwide settlement to resolve allegations that the Lake Forest-based company sought Medicaid reimbursement for ventilation machines that were not medically necessary, California Attorney General Xavier Becerra announced Friday.
California will receive just over $206,000 of a $4.8 million portion of the settlement in connection with the portion of the civil lawsuit that alleged violations of Medicaid laws, according to the Attorney General’s Office.
“When a healthcare company gets lazy and neglects its duty to stay within the bounds of the law, its actions can pose a threat to the health and wellbeing of those who rely on their products and services,” Becerra said in a statement. “It is up to us, working with our state and federal partners, to keep violations like those alleged against Apria in check. This settlement will return the money where it belongs — to help communities in need.”
An Apria spokesperson issued the following statement after the settlement was announced:
“We are pleased to have resolved this civil matter and fully cooperated throughout the review. This settlement relates primarily to whether patients made sufficient use of non-invasive ventilators (NIV), prescribed by physicians for use in patients’ homes, and was based largely on data from the early years of the company’s NIV program. Prior to becoming aware of the government’s interest in the matter in 2017, Apria had already made a number of changes to the NIV program’s processes and procedures relating to patient usage in the home. As always, our patients are our top priority and we remain committed to providing outstanding care and exceptional service.”
The civil lawsuit, filed in February 2017 in New York District Court against Apria Healthcare Group Inc. and Apria Healthcare LLC, alleged that the company sought reimbursements for non-invasive ventilators when it was medically unnecessary or unreasonable. The suit also alleged that the company violated the Federal False Claims Act.
The settlement was negotiated by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse, working with a team of other states and the federal government, according to the Attorney General’s Office.